[1]杨广令陈瑜恒顾宇彤陈延超①高振巢①阿里木①周威力①.徒手微创椎弓根钉内固定联合侧前方小切口手术治疗腰椎结核[J].中国微创外科杂志,2026,01(4):199-205.
　Yang Guangling,Chen Yuheng,Gu Yutong,et al.Freehand Minimally Invasive Pedicle Screw Fixation Combined With Miniaccess Surgery Through Oblique Lumbar Interbody Fusion Approach in the Treatment of Lumbar Tuberculosis[J].Chinese Journal of Minimally Invasive Surgery,2026,01(4):199-205.
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徒手微创椎弓根钉内固定联合侧前方小切口手术治疗腰椎结核()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年4期
页码:
199-205
栏目:
临床研究
出版日期:
2026-04-24

文章信息/Info

Title:
Freehand Minimally Invasive Pedicle Screw Fixation Combined With Miniaccess Surgery Through Oblique Lumbar Interbody Fusion Approach in the Treatment of Lumbar Tuberculosis
作者:
杨广令陈瑜恒顾宇彤陈延超①高振巢①阿里木①周威力①
(复旦大学附属中山医院骨科，上海200032)
Author(s):
Yang Guangling;  Chen Yuheng;  Gu Yutong;  et al.
Department of Orthopaedics, Zhongshan Hospital of Fudan University, Shanghai 200032, China
关键词:
腰椎结核; 椎弓根钉内固定; 斜侧方腰椎椎体间融合术
Keywords:
Lumbar tuberculosis; Pedicle screw fixation; Oblique lumbar interbody fusion
文献标志码:
A
摘要:
目的探讨徒手微创椎弓根钉内固定联合侧前方小切口斜侧方腰椎椎体间融合术(oblique lumbar interbody fusion，OLIF)脓肿引流、病灶清除、植骨融合术治疗无神经症状的腰椎结核的安全性和有效性。方法2015年2月~2018年3月我们对22例无神经症状的腰椎结核(L1~S1)先行徒手微创椎弓根钉内固定（经微小切口椎旁肌间隙入路直视下植入椎弓根钉、皮下穿棒固定），再改为右侧卧位行侧前方小切口OLIF脓肿引流、病灶清除、植骨融合术。术后通过CT评价植骨融合情况。结果22例均顺利完成手术，徒手微创椎弓根内固定手术时间(115.0±7.7)min，侧前方小切口OLIF脓肿引流、病灶清除、植骨融合术手术时间(70.0±10.0)min。侧前方切口长度(4.1±0.5)cm，出血量125(100~400)ml，住院时间6(4~8)d。无切口感染、血管损伤等并发症。22例随访17~25个月，(19.5±2.0)月。腰背痛视觉模拟评分（Visual Analogue Scale,VAS）由术前7(6~9)分下降至术后即刻5(4~6)分(P=0000)，术后1年随访1(0~2)分(P=0.000)。术后1年Oswestry 功能障碍指数(Oswestry Disability Index，ODI)(9.2±29)%，较术前(41.6±10.1)%明显下降(t=16.463，P=0000)。放射影像学评估显示术后1年均获得融合，无一例出现内固定松动、脱落或断裂。3例分别于术后17、20、22个月取出内固定。结论徒手微创椎弓根钉内固定联合侧前方小切口OLIF脓肿引流、病灶清除、植骨融合术治疗腰椎结核安全、有效。
Abstract:
ObjectiveTo evaluate the safety and effectiveness of freehand minimally invasive pedicle screw fixation combined with miniaccess surgery through oblique lumbar interbody fusion (OLIF) approach for abscess drainage, lesion debridement and bone graft fusion in the treatment of lumbar tuberculosis.MethodsA total of 22 cases of lumbar tuberculosis (L1-S1) without neurological symptoms between February 2015 and March 2018 were studied. The freehand minimally invasive pedicle screw fixation was performed via a minimal access in a paraspinal sacrospinalis musclesplitting approach under direct vision for pedicle screws insertion and subcutaneous rod fixation. Then the patients were repositioned to the lateral decubitus position for the OLIF approach to perform abscess drainage, lesion debridement, and bone graft fusion. Postoperative CT scans were used to evaluate bone fusion.ResultsAll the surgeries were completed successfully. The operative time was (115.0±7.7)min for freehand minimally invasive pedicle screw fixation and (70.0±10.0)min for surgery through OLIF approach with the lateral incision of abscess drainage, lesion debridement, and bone graft fusion. The lateral incision was (4.1±0.5)cm in length. The median blood loss was 125 ml (range, 100-400 ml) and the median hospital stay was 6 d (range, 4-8 d). No complications such as incision infection or vascular injury occurred. During a followup for 19.5 months (range, 17-25 months), the Visual Analogue Scale (VAS) of back pain decreased significantly from 7 points (range, 6-9 points) preoperatively to 5 points (range, 4-6 points) immediately after surgery (P=0000) and further to 1 point (range, 0-2 points ) at 1 year postoperatively (P=0000). The Oswestry Disability Index significantly decreased from (41.6±10.1)% preoperatively to (9.2±2.9)% at 1 year after the surgery (t=16.463, P=0.000). Radiographic evaluation confirmed successful fusion in all the patients at 1 year postoperatively, with no cases of screw loosening, displacement, or breakage. Three cases had internal fixation removed at 17, 20, and 22 months postoperatively, respectively.ConclusionFreehand minimally invasive pedicle screw fixation combined with miniaccess surgery through the OLIF approach for abscess drainage, lesion debridement, and bone graft fusion is safe and effective in the treatment of lumbar tuberculosis.

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备注/Memo

备注/Memo:
通讯作者，Email：447574313@qq.com①上海市（复旦大学附属）公共卫生临床中心骨科，上海201508
更新日期/Last Update: 2026-04-24